As we know all too well, times are hard in our public services, and almost the last thing they should be doing is spending money on things that don’t work. The VERY last thing they should be doing is spending money on things that not only don’t work, but might actually be harmful. Surely none are? Well…

As the evidence base evolves it becomes clear that some interventions are effective. However that is not true of all interventions in healthcare. Indeed some treatments are shown to offer no benefits but risk of additional harm.

Health Boards in Wales are committed to reducing harm and waste. So they are drawing up lists of procedures which are believed to be either harmful or of low enough effectiveness to be a waste of resources compared with other options. They have been assisted in this by Public Health Wales who have reviewed evidence not already covered by NICE guidance. Now Public Health Wales is producing a report highlighting variation in provision of surgical procedures of questionable effectiveness.

Variation is not of itself a problem. It may be a sign of provision of specialist care targeted to selected individuals who might gain particular benefit from a treatment not generally advised. The report by Public Health Wales is not able to demonstrate whether the variation is justified in this way. The use of procedures of questionable effectiveness should be justified, however, and the report on variation in provision is the starting point for further investigation by the Health Boards.

This is not the stuff of accountancy penny-pinching. In a finite budget, spending money on things that DON’T work means denying money to things that DO. That’s unethical.

Written by Marcus Longley, Professor of Applied Health Policy and Director of WIHSC